Neuropathic Ulcer

Neuropathy is a broad term that describes a lack of sensorium, movement, or autonomic function and feedback in a particular area. This can be a centralized neuropathy due to paralysis of extremities via distribution of neurotomes, or a peripheralized neuropathy. Most commonly seen in the extremities is a varying degree of peripheral neuropathy. Peripheral neuropathy usually affects only the extremities and can have multiple sources of causality, with the most likely being diabetic peripheral neuropathy. Other sources include shingles (post-herpetic neuralgia), B12 deficiency, alcoholism, autoimmune disorders, Lyme disease, syphilis, HIV, toxin exposure, and hereditary disorders such as Charcot-Marie-Tooth and demyelinating polyneuropathy. Most neuropathic ulcerations occur on the lower extremity and effect prominent pedal surfaces such as the heel and metatarsal heads, or areas of high friction that are prone to callus formation. The three types of peripheral nerves are motor, sensory, and autonomic. The motor nerves allow for the movement of muscles and tissues, and damage can lead to weakness and spasms. The sensory nerves send messages from the tissues to the brain from special sensors that allow us to identify sharp versus dull, rough versus smooth, hot versus cold, and damage can result in numbness, tingling, and pain. Autonomic nerves are involuntary to semi-voluntary systems that regulate homeostasis, and disruption of these pathways can lead to a myriad of issues, including nausea, vomiting, diarrhea, and inability to regulate other bodily functions. Most commonly, there is some form of each of these in patients with progressed neuropathy. However, the progression of the type of neuropathy is based on the underlying etiology and is patient specific. There are some trends that are disorder-specific and often follow a certain progression of nerves affected.